<?php
use yii\helpers\Html;
?>

	<div class="text-c">
		<h1><?= Html::encode($this->title) ?></h1>
	</div>
<div class="layui-container bg-white p60 mt60 settle-wrap">

	<form class="layui-form" action="">
		<div class="layui-form-item border-b pb30 f16">
			<span class="info">账号类型：</span>服务商
		</div>
		<div class="layui-form-item">
			<h3 class="info-title">公司信息<span class="f12 info ml30">公司信息所提交的资料仅用于您在平台进行认证审核所用，我们会对隐私类资料进行保密。</span></h3>
		</div>

		<div class="layui-form-item">
			<label class="layui-form-label"><span class="red">*</span> 公司名称：</label>
			<div class="layui-input-block">
				<input type="text" name="title" autocomplete="off" class="layui-input">
				<p class="info mt f13">请与营业执照名称保持一致。</p>
			</div>
		</div>
		<div class="layui-form-item" id="area-picker">
			<div class="layui-form-label"><span class="red">*</span> 公司地址：</div>
			<div class="layui-input-inline">
				<select name="province" class="province-selector" data-value="贵州省" lay-filter="province-1">
					<option value="">请选择省</option>
				</select>
			</div>
			<div class="layui-input-inline">
				<select name="city" class="city-selector" data-value="黔西南布依族苗族自治州" lay-filter="city-1">
					<option value="">请选择市</option>
				</select>
			</div>
			<div class="layui-input-inline">
				<select name="county" class="county-selector" data-value="兴义市" lay-filter="county-1">
					<option value="">请选择区</option>
				</select>
			</div>
		</div>
		<div class="layui-form-item">
			<label class="layui-form-label"></label>
			<div class="layui-input-block">
				<input type="text" name="title" autocomplete="off" placeholder="请输入详细地址" class="layui-input">
			</div>

		</div>
		<div class="layui-form-item">
			<label class="layui-form-label"><span class="red">*</span> 营业执照注册号：</label>
			<div class="layui-input-block">
				<input type="text" name="title" autocomplete="off" class="layui-input">
				<p class="info mt f13">请输入15位营业执照注册号或18位统一社会信用代码。</p>
			</div>

		</div>
		<div class="layui-form-item">
			<label class="layui-form-label"><span class="red">*</span> 营业执照扫描件</label>					
			<div class="layui-input-inline">
				<div class="layui-upload photo-bak">						  
				  营业执照扫描件
				</div> 
			</div>				
			<div class="layui-input-inline" style="width: 300px;">
				<div class="f13 info">请上传营业执照扫描件，证件信息必须清晰可辨识，支持jpeg、png、jpg格式，大小不超过2.5M。</div>
				<button type="button" class="layui-btn layui-btn-normal mt20" id="btnyyzzimg"><i class="layui-icon">&#xe64a;</i> 上传图片</button>
			</div>
		</div>

		<div class="layui-form-item">
			<h3 class="info-title">联系人信息<span class="f12 info ml30">联系人信息将作为公司认证审核时的重要参考，我们会对您的个人隐私类信息进行保密。</span></h3>
		</div>

		<div class="layui-form-item">
			<label class="layui-form-label"><span class="red">*</span> 联系人姓名：</label>
			<div class="layui-input-block" style="width: 190px;">
				<input type="text" name="title" autocomplete="off" class="layui-input">						
			</div>
			<p class="info mt f13 block ml100 pl80">请填写有效身份证件上的姓名，审核通过后不可修改。</p>
		</div>

		<div class="layui-form-item">
			<label class="layui-form-label"><span class="red">*</span> 联系人证件号码：</label>
			<div class="layui-input-inline">
				<select name="city" lay-verify="required">
					<option value="0">身份证</option>
					<option value="1">护照</option>
					<option value="2">港澳通行证</option>
					<option value="3">军官证</option>
				</select>
			</div>
			<div class="layui-input-inline" style="width: 260px;">
				<input type="text" name="title" autocomplete="off" class="layui-input">
			</div>
		</div>
		<div class="layui-form-item">
			<label class="layui-form-label"><span class="red">*</span> 联系人职务：</label>
			<div class="layui-input-inline">
				<input type="text" name="title" autocomplete="off" class="layui-input">
			</div>
		</div>
		<div class="layui-form-item">
			<label class="layui-form-label"><span class="red">*</span> 联系人手机号码：</label>
			<div class="layui-input-inline">
				<input type="text" name="title" autocomplete="off" class="layui-input">
			</div>
		</div>
		<div class="layui-form-item">
			<label class="layui-form-label"><span class="red">*</span> 联系人邮箱：</label>
			<div class="layui-input-inline">
				<input type="text" name="title" autocomplete="off" class="layui-input">
			</div>
		</div>
		<div class="layui-form-item">
			<h3 class="info-title">账号信息<span class="f12 info ml30">账号信息将在前台页面对用户呈现，为了更好地展示公司形象，建议您认真填写相关资料。</span></h3>
		</div>

		<div class="layui-form-item layui-form-text">
			<label class="layui-form-label"><span class="red">*</span> 公司简介：</label>
			<div class="layui-input-block">
				<textarea name="desc" placeholder="请输入内容" class="layui-textarea"></textarea>
				<p class="f13 info mt10">500个字以内，要求内容完整通顺，无特殊符号。</p>
			</div>
		</div>
		
		<div class="layui-form-item">
			<label class="layui-form-label"><span class="red">*</span> 公司LOGO</label>					
			<div class="layui-input-inline">
				<div class="layui-upload photo-bak">						  
				  公司LOGO
				</div> 
			</div>										
			<!-- <div class="layui-input-inline">
				<div class="layui-upload">
				  <div class="layui-upload-list">
					<img class="layui-upload-img" id="yyzzimg">
					<p id="demoText"></p>
				  </div>
				</div> 
			</div> -->
			
			<div class="layui-input-inline" style="width: 300px;">
				<div class="f13 info">上传公司LOGO图片，请勿添加二维码；支持jpeg、png、jpg格式，大小不超过2.5M。</div>
				<button type="button" class="layui-btn layui-btn-normal mt20" id="btnsqsimg"><i class="layui-icon">&#xe64a;</i> 上传图片</button>
			</div>
		</div>
		
		<div class="layui-form-item border-t">
			<div class="mt30 content">
			<input type="checkbox" name="" title="同意" lay-skin="primary"><a href="" class="mt10 info">《融媒智投服务协议》</a>
			</div>
			<div class="text-c mt30">
				<a href="/user/seller/request" class="layui-btn layui-btn-primary layui-btn-lg">上一步</a>
				<a href="binding_house.html" class="layui-btn layui-btn-lg  layui-btn-normal" lay-submit lay-filter="formDemo">提交申请</a>
				
			</div>
		</div>
	</form>
</div>